| Mariela Licon, LCSW | |
|
1500 N Waterman Ave, San Bernardino, CA 92404-5111 | |
| (909) 703-4099 | |
| Not Available |
| Full Name | Mariela Licon |
|---|---|
| Gender | Female |
| Speciality | Clinical Social Worker |
| Experience | 8 Years |
| Location | 1500 N Waterman Ave, San Bernardino, California |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497201602 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW131192 (California) | Primary |
| 1041C0700X | Social Worker - Clinical | 131192 (California) | Secondary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| St. John's Community Health | 2961482690 | 151 |
| Entity Name | St. John's Community Health |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073653630 PECOS PAC ID: 2961482690 Enrollment ID: O20040722001434 |
| Mailing Address | Practice Location Address |
|---|---|
| Mariela Licon, LCSW 1500 N Waterman Ave, San Bernardino, CA 92404-5111 Ph: (909) 703-4099 | Mariela Licon, LCSW 1500 N Waterman Ave, San Bernardino, CA 92404-5111 Ph: (909) 703-4099 |
Lakenya Reese, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 658 E Brier Dr Ste 200, San Bernardino, CA 92408 Phone: 909-501-0700 |
Ms. Crystal Lynn Blakkan, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1738 N Waterman Ave, San Bernardino, CA 92404 Phone: 909-693-3302 |
Emily J. Taylor, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1255 E Highland Ave Ste 107, San Bernardino, CA 92404 Phone: 909-648-7643 |
Enas Joseph, MSW LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 700 E Gilbert St, San Bernardino, CA 92415 Phone: 909-387-6940 |
Susan Kimberly Gilliam, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2080 S E St, San Bernardino, CA 92408 Phone: 909-388-9191 |
Heidie Kay Page, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 820 E Gilbert St, San Bernardino, CA 92415 Phone: 909-387-7200 Fax: 909-387-7717 |
Dr. Ray Everett Liles, DSW, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1255 E Highland Ave Ste 107, San Bernardino, CA 92404 Phone: 909-645-8579 |